Incidental Findings on Thoracic and Cardiac CT

Abstract

With the ever-increasing use of computed tomography (CT) for imaging, there is always the possibility of finding something on the exam that was not anticipated and is not related to the primary indication for obtaining the exam. These unanticipated findings have been labeled “incidentalomas” and, depending on their significance, a cascade of additional imaging exams can result. Care must be taken to limit unnecessary downstream imaging due to these unanticipated findings. In a patient with an incidental finding, the first task of the radiologist is to determine its stability. An active search of the patient’s prior imaging exams in the picture archiving and communication systems is critical. Appropriate comparison exams may include prior abdominal, renal, or virtual colonoscopy CT exams, magnetic resonance (MR) or ultrasound exams of the liver or biliary tree, or a thoracic or cardiac CT in which the organs of the upper abdomen were incidentally included. For lesions of the thoracic inlet, a prior neck or cervical spine CT may be helpful. If the patient is new to your institution, comparison exams from other institutions can often be electronically transferred and thus obtained with relatively little effort, and are of great value. Obtaining prior exams can save the patient the significant cost, radiation exposure, and anxiety associated with repeat exams. If the “incidentaloma” is new or there are no comparisons to determine stability, a decision must be made regarding the overall significance of the finding, which often has yet to be fully assessed. We have included some of the incidental findings that may be encountered on routine thoracic and cardiac CT imaging, with a focus on their management.